Anterior/posterior repair

Our expectations

You will be able to pass urine normally OR you will be managing self catheterisation.

Your pain will be controlled with oral analgesia.

You will return to and tolerate your usual diet.

Should you require community services, these will be organised for you.

Your expectations and goals

What are your expectations of your hospital stay?

What are your goals regarding this hospital experience and your recuperation?

What community services (if any) do you anticipate you will need (e.g. community nurses)?

Preadmission information

Prior to your admission to hospital, you will be provided with a preadmission form. Please complete this form and return to the hopsital as soon as possible. Please provide as much information as possible. If you currently use a CPAP machine, please ensure that you bring this to hospital with you.

Day of admission and surgery

Admission

On admission you will be taken to the ward.

You will be prepared for surgery and will be asked to sign your carepath to acknowledge your understanding and involvement of your daily care.

You will have an armband applied which will stay on for the duration of your stay for identification and safety reasons. From the ward you will be transferred to theatre.

A safe is provided in the cupboard of your post-op room to store any valuables you have brought to hospital. It is highly recommended that you leave your valuables at home for safety and security purposes.

Discharge planning

You can expect to be in hospital for two to three days or until you have met the expected outcomes for your procedure. Your nurse will discuss with you any needs that you may have following your discharge home.

Please inform staff if you are currently using a Community service, e.g. Blue Nurses.

Teaching and emotional support

Your nurse will explain to you the pre-op/surgical/post-op routine.

Any questions you may have in regard to your surgery or recovery will be answered.

If you would like pastoral care to visit you, please let the staff know and this can be arranged.

Following your operation you will be transferred to the recovery room where you will be observed closely for approximately 30 minutes. You will then be transferred back to your room on your bed once you are fully awake and stable.

Your physiotherapist will visit to explain exercises that will help with your post-op recovery.

Deep breathing, coughing and leg exercises are important for you to do while you are resting in bed after your surgery. These exercises help your circulation and prevent the possibility of clots forming in your veins. To facilitate the deep breathing and coughing, a device known as a TRI-FLO may be given to you.

Deep breathing and leg exercises

Once each hour take five or six deep, slow breaths - relax your shoulders as you breathe out. Bend ankles up and down 10 times every 30 minutes.

Supporting your wound when coughing, sneezing or vomiting

Sit forward in a chair if possible. If in bed, bend your knees up. Place both hands over your wound, with your forearms resting firmly across the abdomen. It may help you to use a pillow across your abdomen as you cough, sneeze or vomit.

Mobilising correctly using your deep abdominal muscles

When you move from sitting to standing, and when you walk, try to gently activate your deep abdominal muscles. Gently draw in the abdominal muscles below your underwear. Placing your hands on your lower abdomen beneath your navel will help you to check the activity of these muscles.

Moving in bed correctly

Slide one heel at a time along the bed towards your buttocks to bend both your knees. Keep your head flat on the pillow. Lift your bottom off the bed as you push through your heels and elbows to move yourself up the bed.

Positioning yourself to avoid straining your repair

When going to the toilet, remember to keep the curve in your back as you lean forward at the hips. Lean your forearms or hands onto your knees (refer to picture on right).

Test and procedures

Any blood tests, X-rays, E.C.G. or other procedures that your surgeon may have ordered for you will be taken care of before you come to hospital or soon after your arrival.

Consults

Your surgeon may visit and discuss your surgical procedure.

Your anaesthetist may also visit. They will discuss your anaesthetic and pain relief following surgery. It is important that you raise any concerns with them.

A pharmacist may visit you to check your medications. You may ask them any questions about your medications.

If you have any family or significant other who you would like the surgeon to speak with after the operation, this will be noted and they can wait in your room or a waiting area. If required your surgeon can telephone them at home or work to update them on your condition. Please provide the nurse with the relevant telephone numbers.

Hygiene

Once you have showered (at home or on admission) you will be required to dress in a theatre gown and some paper pants in preparation for your surgery. Apart from your wedding band, no jewellery or metal is to be worn to theatre. Some tape will be wrapped around your wedding band to cover it.

After you return to the ward you will be given an assisted wash and be dressed in a clean gown.

Mobility

Immediately following surgery you will be resting in bed. You will be encouraged to practice your post-op exercises.

Nutrition

It is necessary that you have nothing to eat or drink for six hours before the operation. Following surgery you may have small sips of water or ice to suck on. You will be given fluids via your I.V. drip.

Elimination

On admission you may be asked for a urine sample for testing. You may require a small enema if your bowels have not opened. After surgery you will have a catheter in place to drain urine from your bladder.

Observations

After surgery the nurse will observe your vital signs and wound dressing for several hours. These observations will become less frequent as you stabilise post-op. Your vaginal discharge will also be observed. You will have a vaginal pack.

Medications

Following surgery you will have an I.V. drip to maintain your fluid intake, pain relief and antibiotic coverage during your post-op period.

You must let your nurse know if you have any pain or nausea, so your medications can be adjusted accordingly.

Following surgery you may have oxygen in place via a mask or nasal prongs. This will be removed in time, according to your observations.

You may need a special injection daily to thin your blood and prevent clotting (e.g. Clexane) if your surgeon orders one.

Treatments

You will be measured for Anti-embolic stockings (TEDS) and will need to have these put on following your shower prior to going to theatre.

A sequenced pressure device will be applied to both your legs (SCDS) before surgery. This helps circulate the blood from your legs back to the heart while you are immobile, reducing the risk of clot formation.

Post-op - day one

Consults

Your surgeon will visit you today and discuss your operation.

Your anaesthetist may also visit to check your progress.

The pharmacist will also visit to check your medication supply.

The physiotherapist may also visit with you today.

Mobility

You are encouraged to increase your mobility today as ordered by your doctor. Your mobility level will depend on when you had your operation. If you had a morning operation you will be encouraged to mobilise this morning. If you had an afternoon operation you may be advised to take it a little slower and not mobilise until this afternoon of Day one post-op.

Hygiene

You are free to shower independently. Assistance will be provided if necessary— especially if you had afternoon surgery.

Nutrition

You may have clear fluids progressing to light diet as tolerated. A record will be kept of your oral fluid intake.

Continence state

Your catheter may remain in place or may be removed today.

NB: When it is removed: each time you want to pass urine it is important to notify your nurse. It is important for your nurse to measure the amount of urine passed and then scan your bladder using an ultrasound device. This is called “Trial of Void” and is done to ensure your bladder is emptying sufficiently.

Observations

Your temperature, pulse, respirations and blood pressure will continue to be monitored regularly and your vaginal discharge will be noted.

Medications

Your I.V. drip may be removed. This is determined by the completion of the antibiotics and whether you are tolerating oral fluids.

When your I.V. is removed and if you have any pain, it will be controlled with oral medications or injections if needed. Remember to let your nurse know if you have any pain.

Treatments

You need to continue to wear your stockings.

The SCDS will be removed when you are able to walk around.

Today your vaginal pack may be removed. This procedure is similar to the removal of a tampon. You may experience some mild discomfort and there may be some small blood loss after removal. It is important to inform your nurse if the bleeding becomes bright and heavy.

If you have had the Trans Vaginal Tape procedure your wounds will be observed for healing.

Teaching/counselling

You will be encouraged to perform your deep breathing, coughing and leg exercises while resting in bed and remember to use the information provided by your physiotherapist.

Post-op - day two

Consults

Your surgeon may visit you today.

The pharmacist may visit you today.

The physiotherapist may also visit you today.

Mobilisation

You will be encouraged to sit out of bed and increase your mobilisation today.

Hygiene

You are free to shower independently—assistance will be given if needed.

Nutrition

Today you may increase your diet from a light diet to eating food as you desire.

Continence state

If your catheter has not been removed, it will be removed today.

Observations

Your temperature, pulse, respirations and blood pressure will continue to be monitored regularly.

You will be asked if you have any vaginal discharge.

Medications

If your IV has not been removed already you most likely are ready to have it removed today.

You will be given all your usual medications.

Your pain will be managed with oral medications or injections if needed.

Treatments

You will continue to wear your support stockings as ordered.

Your vaginal discharge will be monitored.

If you have had the Trans Vaginal Tape procedure your wounds will be observed for healing.

Teaching/counselling

You will be encouraged to perform your deep breathing, coughing and leg exercises while you are resting in bed.

Post-op - day three

Consults

Your surgeon will visit you today.

The pharmacist may also visit.

Mobility

You will be encouraged to take short walks. Assistance will be given if needed.

Sit out of bed as tolerated.

Hygiene

You are free to shower independently—assistance will be given if needed.

Nutrition

You may increase your diet from a light diet to eating food as you desire.

Continence state

It is expected that you will be passing urine normally today.

Please notify nursing staff if you are experiencing pain or burning when you pass urine.

A medication may be ordered to help you move your bowels, if you are having difficulty.

Observations

Your temperature, pulse, respirations and blood pressure will continue to be monitored and your vaginal discharge will be noted.

Medications

Your pain will be managed with oral medications.

You will continue to take your usual medications.

Treatments

You will continue to wear your support stockings as ordered.

Teaching/counselling

You will be encouraged to perform your deep breathing coughing and leg exercises while you are resting in bed.

If you have had the Trans Vaginal Tape procedure your wounds will be observed for healing.

Discharge planning

Depending on your recovery, you may be able to go home today.

Day of discharge - day four

Consults

Your surgeon will visit you today.

Mobility

You may walk as much as you like.

Hygiene

You are free to shower independently—assistance will be given if needed.

Nutrition

You may eat food and fluids as desired.

Continence state

It is expected that you will be passing urine normally today.

Observations

Your temperature, pulse, respirations and blood pressure will be monitored prior to going home and you will be asked if you have any vaginal discharge.

Medication

If you have any pain it will be controlled with oral analgesia.

Your medications on discharge will be summarised for you on a discharge advice form which will be given to you.

Treatments

You will need to wear your stockings—especially overnight for one to two weeks.

Your vaginal discharge will be monitored.

If you have had the Trans Vaginal Tape procedure your wounds will be observed for healing.

Teaching/counselling

A discharge advice form will be given to you prior to discharge. An information guide is also provided with this information package.

Discharge planning

Discuss any concerns you may have with the staff.

You will need to organise a follow-up appointment following discharge.

When you are ready to leave the hospital, you will be escorted to the discharge desk by a staff member.

A copy of your discharge summary (information on your surgery and follow-up care) will be sent to your GP.

You will be confident with managing self catheterisation at home, if applicable.

Advice following anterior posterior repair

What to expect

You may have a watery blood stained discharge for the first couple of weeks. As healing takes place you may experience some dark spotting as the internal sutures dissolve.

You may feel fatigued.

You may need to take some simple analgesia e.g. Panadol for pain or discomfort— especially on waking and settling at night.

What to avoid

Avoid strenuous activity and heavy lifting for six to eight weeks.

You should mobilise around the house and yard initially then go for short walks. Aim to gradually increase your activity everyday.

Avoid sexual activity for six to eight weeks to allow time for healing to take place. Avoid straining when opening your bowels.

Avoid constipation by eating a diet high in fibre and drinking two to three litres of fluid a day.